**Hull University Teaching Hospitals NHS Trust - Nuclear Medicine** 


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[[sqlite:unused:unused:unused:/home/heynmorg/public_html/wiki/data/meta/examcodes/database.db|SELECT sop AS "SOP Code",title AS "Title",reviewdate AS "Review Date" FROM sops WHERE sop='REF006'|0]] 
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^  Authorised By  ^  Authorising Role  ^  Authorisation Signature \\  (only on master paper copy)  ^  Date Authorised  |
|   Dr I Sunderji            | ARSAC Licence Holder     |                                                           |   2024-07-08         |

====== REF006 - Cardiac Amyloidosis Imaging Referral Criteria ======
See [[referral_criteria:ref000-how_to_refer_to_huthnm|REF000 - Referring to Nuclear Medicine (HUTH)]] for details of how to refer.
===== Description =====
Myocardial uptake of the radiotracer Technetium-99m-DPD has been validated and increasingly used in the non-biopsy diagnostic pathway of transthyretin related cardiac amyloidosis (ATTR). It offers a highly sensitive tool for detecting this disease and plays a key role in the non-invasive diagnostic workup of these patients[([[https://journals.lww.com/nuclearmedicinecomm/fulltext/2024/04000/recommendations_for_good_clinical_practice_for_dpd.1.aspx|Wechalekar, Kshama; Hutt, David; Quigley, Ann Marie; Whelan, Carol; Chan, Pei San; Hossen, Lucy; Armstrong, Ian; Arumugam, Parthiban; Moody, William; Wechalekar, Ashutosh D. Recommendations for good clinical practice for DPD bone scintigraphy for cardiac amyloidosis. Nuclear Medicine Communications 45(4):p 253-262, April 2024. | DOI: 10.1097/MNM.0000000000001796]])]. However, it should be noted that DPD imaging is neither a primary tool to diagnose amyloid cardiomyopathy nor a tool to exclude cardiac amyloidosis on its own.

[[sqlite:unused:unused:unused:/home/heynmorg/public_html/wiki/data/meta/arsac/database2019.db|SELECT fullname AS "ARSAC Licence Holders", investigation AS "Indication" FROM practitionerlicences INNER JOIN practitioners,procedurecodes,praclicproc,nuclides,chemicalforms ON practitionerlicences.practitioner=practitioners.id AND praclicproc.plicid=practitionerlicences.id AND praclicproc.procid=procedurecodes.id AND procedurecodes.nuclide_id=nuclides.id AND procedurecodes.chemicalform_id=chemicalforms.id AND practitionerlicences.certificateactive='Y' WHERE procedure_code='99mTc-39-22'  AND date('now')<=expirydate  ORDER BY expirydate|0]]

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^                              ^ Radiopharmaceutical  ^  CT component of SPECT/CT  |
^Typical Radiation Dose (mSv)  |   5.6   |   0.5    |

===== Staff Entitled to Refer =====
All UK registered practitioners

===== Supplementary Drugs =====
Sodium chloride for parenteral use (0.9% w/v).

===== Contraindications =====
Pregnancy

===== Clinical Indications =====
|Clinical suspicion of amyloid involving the heart[(#1)][([[https://doi.org/10.1016/j.jcmg.2011.03.016|Rapezzi C, et al. Role of (99m)Tc-DPD scintigraphy in diagnosis and prognosis of hereditary transthyretin-related cardiac amyloidosis. JACC Cardiovasc Imaging. 2011 Jun;4(6):659-70. doi: 10.1016/j.jcmg.2011.03.016. PMID: 21679902]])]  |